Leiomyosarcoma of the breast. A clinicopathologic and immunohistochemical study

Leiomyosarcoma of the male breast: Case report

Introduction

Primary sarcoma in man is very rare and knowledge about this tumor is limited with very few cases published in the literature.

Case report

A 65-year-old man operated on 20 years ago for a left breast tumor with a skin graft at the tumor site (no documentation or pathology report). He consulted for a mass in the left breast, bleeding on contact, associated with nodules in the right breast that looked suspicious. On breast ultrasound, a tissue formation in the lower medial quadrant of the left breast with irregular contours, measuring 42 × 53mm with the presence of several suspicious tissue formations in the right breast, the largest measuring 2 × 2cm.

Surgical removal of the left mass with a right mastectomy with pathology report of breast leiomyosarcoma with healthy surgical borders followed by radiotherapy for local control.

Discussion

Leiomyosarcoma is an extremely rare tumor in the breast and usually originates from the blood vessels, myoepithelium, or nipple musculature, as in our case. Breast sarcomas represent less than 1% of all malignant neoplasms of the breast. Their incidence in women is much higher than in men.

Conclusion

Primary breast sarcomas are rare tumors that originate from the mesenchymal tissue of the breast and represent less than 1% of all malignant neoplasms of the breast. Their diagnosis is confirmed by biopsy with immunohistochemical and only surgery can guarantee cure. Radiotherapy is recommended for local control after surgery.

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Primary sarcomas in man are very rare and knowledge about this tumor is limited with very few cases published in the literature.

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The diagnosis is histological, a histopathological examination followed by an immuno-histochemical analysis is very important for a precise diagnosis.

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Surgery is the only guarantee of recovery. radical mastectomy with surgical margins of at least 3cm is the standard procedure.

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Axillary lymph node dissection is not recommended.

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Radiotherapy is recommended for local control after surgical excisioN.

Breast Leiomyosarcoma: A Systematic Review and Recommendations for Management

Background

Leiomyosarcomas of breast are very rare tumors, with only 54 cases reported in the literature to date.

Methods

We report a case of leiomyosarcoma in a 52-year-old woman who presented with a painless left breast mass in the upper outer quadrant of her left breast. It measured about 6 cm in diameter and was located within the breast parenchyma with no skin involvement. Mammogram was suggestive of BI-RADS IV lesion, and core biopsy of the lesion was inconclusive.

Results

Histopathology and immunohistochemistry of the excision biopsy of the mass confirmed the diagnosis of leiomyosarcoma approaching the specimen margins. The patient underwent simple mastectomy, which did not reveal any residual tumor or additional lesions. Follow-up for a year after her mastectomy did not show any local or systemic recurrence.

Conclusions

We reviewed the literature and summarize our findings as recommendations for management of leiomyosarcoma of breast.

Cutaneous/subcutaneous mesenchymal proliferations of the breast

Cutaneous mesenchymal "spindle cell" lesions arising in the vicinity of the breast represent a complex clinical and diagnostic scenario which may overlap histopathologically and immunohistochemically with mammary spindle cell proliferations, potentially impacting management and overall prognostication. In this review, we suggest a pattern-based approach to assist in the evaluation of these lesions. A comprehensive description of each entity is accompanied by a cutaneous and mammary differential diagnosis.

Primary leiomyosarcoma of breast in an adolescent girl: a case report and review of the literature

Leiomyosarcoma of the breast is a rare neoplasm, primarily reported in older women. Only 44 cases have been reported in world literature and to the best of our knowledge, no case has been reported from India till date. We report a case of primary breast leiomyosarcoma in an adolescent girl who underwent a lumpectomy for rapidly increasing lump in the left breast. Here we report the histological findings and immunohistochemical profile of this entity, along with a review of existing literature.

Primary leiomyosarcoma of the male breast: a case report

Primary leiomyosarcoma of the breast is a rare tumour with only around thirty cases reported in the literature. Most of the cases reported are in females, while only a few are reported in males. We present a case of primary breast leiomyosarcoma in a 59-year-old man that presented with a subareolar lump which felt to be benign clinically and radiologically but proven to be a leiomyosarcoma on excision.

Primary leiomyosarcoma of the breast treated by partial resection of the breast including nipple and areola: report of a case

A 46-year-old female patient presented with a tumor measuring 0.5 cm in diameter under the areola of the breast. Because no definite malignancy was found with inspection and palpation, imaging analysis, or with a fine-needle aspiration cytology examination, follow-up observation was recommended. When the patient visited the hospital 6 months later, the mass was 0.9 cm in diameter. The tumor was excised and histopathologically diagnosed as a leiomyosarcoma. Subsequently, the patient underwent a partial resection of the breast, including the nipple and areola. A follow-up examination revealed no evidence of distant metastasis or local recurrences 8 years 4 months after the surgery. Primary leiomyosarcoma of the breast is extremely rare. Only 33 cases, which are reviewed in the present study, have been previously reported in the literature.

Primary leiomyosarcoma of the nipple-areola complex: report of a case and review of literature

Primary leiomyosarcoma of the nipple-areola complex is extremely rare. Less than ten such cases have been reported in English literature so far. Herein we describe a 52-year-old female presenting with a 1.5 cmx1.1 cmx0.7 cm nodular lesion over her left nipple, and leiomyosarcoma was proved by pathological examination of the excised specimen. Positron emitted tomogram (PET) revealed no abnormal signal other than the primary site. Microscopically, this poorly circumscribed tumor was composed of interlacing bundles of smooth muscle cells with bizarre and pleomorphic nuclei, as well as prominent nucleoli. Its mitotic count was up to 7 mitoses per 10 high power fields (HPF). Immunohistochemical study of tumor cells revealed positive stain for alpha-smooth muscle actin and vimentin; and negative for cytokeratin, CD34 and S-100. Left simple mastectomy was undertaken and no residual mass lesion was noted on the resected specimen. Related literatures about the diagnosis and treatment for breast leiomyosarcoma will be presented here.